From the Trenches: Leadership Strategies from the US Navy ...€¦ · Divurgent’s Leadership Development Program is based on teaching skills in three core competencies: building

Redefining Consul�ng. Transforming Healthcare.

LEADERSHIP SERIES

From the Trenches: Leadership Strategies from the US Navy SEALs Applied to Healthcare

white paper

written by

Colin Konschak, Divurgent CEO & Managing Partner

Commander Jamie Sands, former Commanding Officer of SEAL Team 8

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Introduction

The art of leadership has been a subject of study and relevance since the dawn of human interaction. Throughout history, the actions of leaders have created great empires, sparked scientific discovery, and inspired positive change. Successful organizations today have one common denominator: effective leadership. Skilled leaders provide organizations with vision and communicate the purpose of an organization to motivate team members across all levels. Leaders strengthen the performance of members throughout the organization, resulting in a snowball effect that permeates the entire enterprise.

Military organizations, and the Navy SEAL teams in particular, have track records of producing great leaders who have positive influences on those around them. The principles behind solid leadership in the military apply at all levels of the organization and for virtually every interaction, whether it’s a general leading their troops into battle or an officer training new recruits. These strategies, which have worked for several decades, are widely applicable in the healthcare field today.

The need for effective leadership is greater than ever in healthcare today. Accountable care organizations (ACOs), clinically integrated networks (CINs), patient-centered medical homes (PCMHs), and safety net providers alike are embroiled in a “perfect storm” that has changed the landscape of the United States (U.S.) healthcare environment. Challenges occurring that have led to this “perfect storm” include: 1

Challenge Example

Regulatory policy reform 2010 Patient Protection and Affordable Care Act (PPACA); 2011 Medicare Shared Savings Program (MSSP).

Financing, incentivizing, and reimbursement of healthcare services

Medicare reimbursement rate reductions; 2010 CMS Meaningful Use of Electronic Health Records (EHRs) Program.

Access to services Challenges for patients in having sufficient health insurance, and finding physicians that accept payment from the insurer.

Measuring quality outcomes Continuously evolving sets of clinical quality and operational measures to evaluate impact on the health of targeted populations.

Influx of technology and innovation Implementation and adoption of electronic medical records (EMRs), health information exchange (HIE), and other technologies.

Without effective leadership to empower staff and set a solid strategy, the ship can get off course with the occurrence of medical errors, delays in treatment, negative returns on investments, and adverse consequences in light of the challenges faced in this “perfect storm.”

To help meet the needs of the industry for solving leadership challenges, Divurgent has launched a leadership development program based on creating and strengthening competencies and methods for program participants as originated in Navy SEAL team training. This program is aimed at developing a culture of leadership that provides vision, long-term strategy, and sustainable growth. Our program utilizes a phased approach, as shown in Figure 1 below that targets a number of core competencies at different phases in a professional’s career. The program offers techniques and tools to continue and strengthen the development of clinical, technical, and administrative professionals as leaders in their chosen field.

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Figure 1. Phases of Leadership Development2

Phase I: Develop a foundation of technical competence and gain experience

Phase II: Become independent contributors

Phase III: Become mentors

Phase IV: Organizational visionaries

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Com

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Effec

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Thin

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Divurgent’s Leadership Development Program is based on teaching skills in three core competencies: building trust, strengthening communications, and thinking critically. These competencies build on one another, and are introduced at different points in an individual’s career. Leadership career levels are identified in the pyramid as Phases I through IV, and represent a progression from early career stage, where basic competency growth and understanding is key, to advanced stages, where mentorship and visionary roles become essential. Like any project worth pursuing, leadership development is a long-term and gradual process that involves the investment of time and resources. There is no magic button to build a great leader – it takes time and planning. In today’s U.S. healthcare system, one constant for leaders to address is change, and as Peter Drucker noted in his 1999 classic Management Challenges for the 21st Century,“…change is the norm.”3 An information revolution has descended upon the U.S. healthcare industry, and leaders are needed who can embrace technologies and integrate them into organizational strategies for growth and population health improvement. Then in 2001, in one of the Institute of Medicine’s (IOM) landmark reports Crossing the Quality Chasm, A New Health System for the 21st Century, the IOM emphasized the need for leaders to be capable of managing change and:

“…creating and articulating the organization’s vision and goals, listening to the needs and aspirations of those working on the front lines, providing, directing, creating incentives for change, aligning and integrating improvement efforts…that encourage and enable success.” 4

The IOM’s acknowledgment of the importance of change was a paradigm shifting point for healthcare over a decade ago and today it is still recognized as a key factor for leaders in understanding the evolving healthcare environment.

In this paper, a phased approach is introduced to leader development, targeting these three critical competencies of great leaders, detailed in the following sections. We will teach early career professionals to build trust in an organization, master communication skills with mid-level leaders, and develop their critical thinking skills for improved communications with senior executives. The end state of leader development is the CEO. By the time he or she fills that role, they will have mastered the three critical competencies of leadership. Properly executed, this phased approach to leader development introduces all three competencies throughout a person’s career, but targets a specific competency during each phase. This approach will allow organizations to develop their most valuable assets: the individuals who work there. Not everyone in an organization will have the term leader in his or her job title, but for an organization to be great, everyone needs to be.

Competency 1: Build Trust

Much like a great general needs the unconditional trust of his soldiers on the battlefield, a healthcare executive needs the unwavering trust of his clinical and administrative staff as the organization works to reach its goals for improving patient care and the quality of health for the communities they serve. Building trust is the ability, above all others, needed to lead effectively, and requires relationships based on mutual respect. This skill should be developed in early career professionals so they can continually draw upon it as they move up the ladder. There are several methods that can be used to build trust that are based on the following principles:

Know your people. The greatest leaders in history have shared a common trait of understanding human nature and the psychology of their followers. Leadership is inexorably tied to human psychology, and a leader’s understanding of his followers is essential to his or her success.5 As General Douglas McArthur wrote:

“The leader must have developed to the highest degree his own understanding of human nature … for in battle men will follow only those whose demonstrated efficiency inspires confidence and respect.” 6

An understanding of human nature allows the leader to succeed in a complex environment. Effective leaders need to take an active interest in the lives of the people who work for them. This is best accomplished by looking for common ground that connects you to your staff. Knowing what is going on in their lives and engaging them in conversation about it will help build positive and supportive relationships. For example, when you walk up to an employee and ask how his or her son did in his football game last weekend, you are talking about things that matter to your employee, and as a leader, this simple gesture is very powerful.

Establishing relationships at this level can lead to creation of a “safety zone” as noted by Goleman and colleagues in their 2006 work on Primal Leadership.7 Having this “safety zone,” a three minute conversation in the hallway with your employee, will resonate with that team member; moreover, this will establish and reinforce that he or she is valued as a person, and is a key element to the success of your organization. These personal relationships are not distractions, they are requirements for success. In healthcare, it is how we cultivate and manage relationships which can both directly and indirectly effect the quality of care the organization delivers to the people it means the most to: the patient.

Don’t ask them to do anything you haven’t done or wouldn’t do if you were in their position. As a leader, you don’t need to master every skill required of all your team members, but you do need to recognize and value what they’re doing. A commander of a SEAL team wouldn’t ask someone to do a 12-hour dive off a submarine unless he had done it himself or


would do it, but is unable to because of other responsibilities. Just as a commander would never ask a staff member to do something that isn’t safe, a healthcare leader shouldn’t ask staff or a team member to perform a task that is degrading, humiliating, or well beyond their skill and experience in clinical, technical, or administrative operations of the healthcare environment.

Do what you say and say what you do. This may sound simple, but it involves a lot of work and a certain mind set. Be honest with your team and avoid making false promises. This holds true even for minor details. For example, if you schedule a meeting at a certain time, be there at the appointed time. This demonstrates reliability, which facilitates trust and builds shared respect. The message to your people in this: Your time is important to me, therefore you are important to me.

Be 100% accountable for your organization. Don’t dwell on success and don’t hide from failure. Not only should you take responsibility for your own actions, you should do it for the actions of those who work for you. This is known as “top cover” in the military. People will inevitably make mistakes, and if you throw them under the bus, it will erode previously earned trust. Your staff needs to know you’ll take responsibility for their actions. Encourage your personnel to take risks for improvement, and understand that failure is an inevitable step to successfully achieving goals albeit in clinical, administrative, and technical operations.

Understand and promote your organization’s culture. Perhaps the most critical aspect of leading an organization is understanding and articulating your “why.”8 As a leader, you must understand why you are doing things in your organization. Recognize the importance of your organization’s culture and adapt capabilities, agendas, and concerns of your colleagues to fit the culture and its values.

Building Trust Up, Down, and Across. Building relationships is important not just for those you supervise, but also for those who supervise you and your peers. Making sure you deliver what you promise and demonstrating your reliability are the keys to these relationships. Keep your supervisor up-to-date on what you’re doing with your staff. For instance, summarize employee evaluations and schedule an appointment to review them with your boss. Convey how well you know your staff, and how you are managing them in line with the culture of the organization. It’s better to over-communicate, especially when beginning a new job. Once you get feedback, you can tailor communication to a level where your supervisor is comfortable with, and knows what’s going on without being overly involved.

You will also need to build trust with different departments in your organization and external to your organization. You and your team are all part of a larger enterprise, so in order to be effective as a unit you will have to demonstrate to people in other areas the same level of reliability that you display to your staff and supervisors. Actively avoid conflict (not competition) with your peers, and be aware of not injuring their pride. Keep in mind what Abraham Lincoln said, “A drop of honey catches more flies than a gallon of gall.”

Strategies for Building Trust. One of the most effective strategies for building trust is a 360 degree assessment. The concept here is to obtain feedback from every direction—above, below, and laterally. Normally, supervisors give feedback to those who report to them regarding their job performance. With the 360 degree approach, you will get unfiltered, anonymous feedback about your performance from those who work for you. While this can be unsettling and not always positive,


especially for those higher up the chain, it is invaluable. A 360 degree assessment offers an opportunity to adjust your leadership style and improve your leadership skills and tactics utilized with staff. There are very few great leaders who think they cannot learn. The best of us actively seek out constructive feedback on our strengths and weaknesses. The more vulnerable you allow yourself to be, the greater the bonds of trust you will build in your organization. The reality is that your employees don’t miss a thing—you are only fooling yourself and feeding your ego when you resist feedback.

Counseling is a strategy that supports knowing your people and leads to increased trust within your organization. Knowing about your employees’ families and their lives outside of work will open up avenues of communication and connect your employees with you and the organization, albeit a healthcare technology vendor, physician practice, or hospital network. When evaluating your employees, start with identifying three areas for improvement. After addressing the things they can do better, and providing them with advice or resource suggestions for making the improvements, move on to highlight three things they’re doing really well. Even if you have to start the meeting on a negative note, they will leave with a positive attitude and will be grateful for the honest feedback. Now, you have enabled self-improvement for your employee and greater success for your company.

The ways in which you communicate with your staff and supervisors involve small changes that seem simple, but can have a big impact. For instance, the way you greet someone and whether or not you make eye contact can set the tone for an encounter. It’s important that your manner instills confidence with those who depend on you for leadership and guidance in efforts to gain consensus for plans, strategies, and tactics in clinical and administrative settings. To support the development of this first competency, having strong communication skills will be essential to building trust with staff, team members, and supervisors in your organization.

Competency 2: Communicate Effectively

Communication skills need to be mastered by mid-level professionals as they work toward senior executive levels throughout their career. Effective communication requires an understanding of human nature, but it also requires sound writing skills to convey the right messages in various types of collateral (e.g., e-mails, briefs, proposals, etc.), as well as oral skills, whether speaking to an individual or a large group. Some forms of communication, such as PowerPoint presentations, require both written and oral skills.

Public speaking is a particularly important skill to master because if you can’t speak well publicly, it will limit your effectiveness as a leader. Some people are charismatic in one-on-one situations, but fall apart in front of a group, which can erode the confidence of the speaker and weaken the delivery and reception of their message. On the other hand, if you speak well and convincingly, it can increase the confidence others have in your abilities as a leader, even if they disagree with what you’re saying.

Leaders must be introspective, or self-aware, and recognize their strengths and weaknesses. Someone who is a skilled public speaker can write down three points on a note card five minutes before a meeting and perform admirably. On the other hand, someone who is not a good public speaker will need to prepare and rehearse well ahead of time before addressing a group. You may end up deviating from your script, but it will help you communicate clearly, and ensure that you get your points across in the allotted time. Keep your message concise, and figure out what works for you. If you prepare adequately ahead of time, this should not prove to be difficult.


Sound communications help build trust. Above all else, knowing the audience is critical. In healthcare, much of the intent of communications for clinical, administrative, and technical leaders is about building and managing relationships to strengthen collaboration, which is grounded in trust.9 The healthcare environment is highly complex, with independent agents and stakeholders that can influence clinical decision-making, operational plans, or health policy, all of which effect a patient’s care and the organizations that provide care delivery services. In the military, chain of command is essential and relationships are highly linear in nature, requiring consistency in messaging and acknowledgment of authority and power in the flow of communications. However, in healthcare there are more non-linear relationships to be managed where stakeholders and team members may not be accountable under the same command and control structure. Recognizing this element of the environment is essential and increases the importance for the leader and aspiring leaders across the healthcare industry to refine their communication skills to support improving their abilities for negotiations, consensus building, and relationship management in both clinical and administrative settings.

In order to establish trust in the healthcare environment with effective communications, every leader needs to develop and establish procedures and tactics to ensure their success. In the military, procedures are used to instruct people on what to do in all types of situations. For example, the “safety on/safety off” procedure means that before going into a room the safety switch is off on your weapon; then you enter, assess the situation, and put the safety on. Similarly, a leader needs to develop procedures that better enable their ability to communicate, such as a note card with bullets, an outline, or a script. You need to determine what form of communication is best for different situations, which medium to use, and how to modify your style to accommodate your audience. These techniques, known as tactics in military communications, will help get your message across effectively and strengthen your own confidence as a leader.

The Divurgent Leadership Development Program will help you hone these essential communication skills to be better equipped for managing relationships, building trust, and delivering the right message. In the healthcare environment, your messages are delivered to stakeholders and team members, ranging from nurses on the front lines of care, community physicians, health IT staff, hospital executives, healthcare attorneys, and others.

Competency 3: Think Critically

Critical thinking is the bottom line that preserves the existence of your organization. It involves the ability to examine a problem, apply your experiences to it, and come up with the right decision to solve it. Critical thinking requires a level of maturity. It is developed by way of a “rolodex of experiences,” which takes time and experience to develop. This is the third competency to master in a professional’s career.

The Divurgent Leadership Development Program focuses on planning to promote critical thinking, as well as:

• Applying what you know

• Recognizing what you don’t know

• Requesting, analyzing, and accepting feedback

• Making the right decision for your organization

These steps offer a process to organize problems, frame them, define the critical facts and assumptions, and devise a course of action. Once this is accomplished, each course of action is analyzed, taking into account the advantages and


disadvantages it confers. This activity takes place by leading a strong planning team to develop and make decisions using this process. Putting together the planning team is a skill in itself. It requires self-awareness in order to select members who have the experience you lack. Fortunately, you’re not limited by your own experiences when it comes to critical thinking. You can become a better critical thinker through these experiences, but also by learning from the experiences of others. In this way, you can utilize others’ successes to avoid making mistakes.

Making decisions can be discouraging and overwhelming, but the techniques learned in the program will teach you how to mitigate the complexities of the ever-changing healthcare environment to bring order out of the chaos, frame problems and organize decisions, and avoid the pitfalls of relying on emotions instead of facts. An operational focus for healthcare involves making life or death surgical and treatment decisions for patients. This can be paralleled with a naval commander’s wartime decision-making around the “golden hour” in balancing medical attention for their crew’s injured combatants with continuing to engage in combat actions to complete mission requirements. Strengthening abilities for making effective decisions in situations such as these are core to the mission of this program.

One technique, adapted from the military is the military decision-making process (MDMP), can be highly beneficial in planning for a healthcare organization’s future. MDMP was developed as a military-wide analytical, proven process, and can work for your organization as seamlessly as it works for military operations. While it has many levels and applications, a basic example is as follows:

• Mission: Identify the problem or task – what do you need to get done?

• Environment: Who and what can impact your mission? The military considers everything from weather to political will. Are there other organizations actively working for or against you in the marketplace?

• Time: How much time you have before you need to execute? Don’t rush into failure by making an uninformed decision, but don’t miss opportunities through indecisiveness.

• Define the facts and your assumptions: Establish what you know to be true (facts) and what you need to be true (assumptions) to continue to plan.

• Course of action: After analyzing the above components, decide upon several courses of action. Ensure they are distinct from one another, feasible (they can actually be accomplished), and acceptable (in line with your organization’s culture and leadership).

When executed correctly, the MPDP prevents mistakes. It ensures your organization does not make false assumptions or neglect facts before moving forward with a new concept or making a critical decision. Similarly, in healthcare operations (e.g. surgeries, medication administration, etc.) requiring precise clinical decision-making, operational planning is essential to reduce the risk of medical errors and medical harm.

Conclusion

The three core competencies discussed throughout this paper support the four phases of Leadership Development, and can’t be developed through a one-off approach. The four phases of a leader’s career development in the Figure 1 pyramid will be discussed in more depth as the Leadership paper series continues.


As Figure 1 illustrated, the three competencies and four phases are not static or generic, but rather interdependent, overlapping, and progressive, which requires constant attention and adjustment. Developing effective leaders for U.S. and global healthcare organizations is not unlike that of the development of U.S. Navy SEAL team leaders and other military commanders. It is a long-term process that requires targeted development and dedication at each stage in the professional’s career. While this requires time and effort—the benefits to your organization, regardless of the industry, in productivity, ingenuity, high morale, and success make leader development a key differentiator between organizations satisfied with the status quo and those that strive to achieve greatness in operational excellence and their ability to serve the greater good of their community and nation. As noted by one of our nation’s great military leaders, Colin Powell:

“The leader sets an example. Whether in the Army or in civilian life, the other people in the organization take their cue from the leader—not from what the leader says, but what the leader does.” 10

Leadership skills can be learned, and effective leaders understand their importance regardless of whether they lead a nursing unit, hospital, Navy SEAL team, or nation. It’s critical to serve as a model of excellence for those who look to you for mentoring and guidance. Through this eadership development program, these necessary skills, traits, and other important facets of leadership will be honed and strengthen to help cultivate strong and impassioned leaders for the twenty-first century healthcare industry.

References

1. Adapted from: Bozic KJ. Healthcare Economics and Policy: It’s a Perfect Storm. PR Newswire. June 1, 2010. Accessed online March

11,2013athttp://www.prnewswire.com/news-releases/healthcare-economics-and-policy--its-a-perfect-storm-95336979.html.

2. ZengerJH,FolkmanJ.TheHandbookforLeaders–24LessonsforExtraordinaryLeadership.Columbus,OH:McGraw-Hill.2006.

3. Drucker PF. The Change Leader. In: Management Challenges for the 21st Century. New York, NY: HarperCollins Publishers, Inc;

1999:73-93.

4. InstituteofMedicine,CommitteeonQualityofHealthCareinAmerica.LeadershipforManagingChange.In:CrossingtheQuality

Chasm.ANewHealthSystemforthe21stCentury.Washington,DC:NationalAcademiesPress;2001:137-40.

5. CaptAdolf Von Schell, StaffCorpsGermanArmy. Battle Leadership, (Quantico, VA: TheMarineCorpsAssociation, June 2007).

LessonsonbattlecommandandleadershipwrittenbyaGermanofficerwhoservedincombatthroughoutEuropeduringWWI.

6. GENDouglasMacArthur,USA.ReportoftheSecretaryofWartothePresident1933,(Washington,DC:UnitedStatesGovernment

PrintingOffice,1933).

7. GolemanD,BoyatzisR,McKeeA.TheFifthDiscovery:ThePowerofRelationships. In:PrimalLeadership.RealizingthePowerof

EmotionalIntelligence.Boston,MA:HarvardBusinessSchoolPublishing;2002:161-63.

8. SinekS,StartwithWhy:HowGreatLeadersInspireEveryonetoTakeAction.London,England:PenguinBooksLtd;2009.

9. ParrishB,BurkeRE:ManagingRelationshipsandEffectiveCommunication.In:BurkeRE.,FriedmanLH,eds.EssentialsofManagement

andLeadershipinPublicHealth.Sudbury,MA:JonesandBartlettLearning.2011;117-124.

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Redefining Consul�ng. Transforming Healthcare.Redefining Consulting. Transforming Healthcare. ©2015DIVURGENT.Allrightsreserved.|9

ABOUT THE AUTHORS

Colin B. Konschak RPh, MBA, FACHE, FHIMSS. In his role with Divurgent, Colin leads the Divurgent Team in transforming healthcare with our clients for the communities they serve. He ensures client satisfaction is at the forefront of every project, oversees company operations, and encourages growth and innovation among the Divurgent Team. His passion, paired with 20 years in healthcare, has driven Divurgent in improving the patient experience and operational strategies in the healthcare industry with new and innovative solutions.

Colin’s industry expertise ranges from pharmaceuticals, provider and payer markets, Health IT, to Accountable Care Organizations, a trend in which he has particular interest in. Author of two books,speaker and thought leader—he has notable influence within the healthcare community.

Currently, Colin is serving as a Fellow in the Healthcare Information Management Systems Society (HIMSS) as well as Past President and Programs Chair of the Virginia HIMSS Chapter. Colin is also a member of the American College of Healthcare Executives (ACHE).

Colin earned a B.Sc. from the University of Sciences in Philadelphia in Pharmacy and a Master’s in Business Administration from Old Dominion University, and is also a Certified Professional in Healthcare Information Management Systems.

Milton “Jamie” Sands. Commander Jamie Sands graduated from the Naval Academy with a BS in Oceanography. He earned an MS in Military Strategy and Planning from the Joint Advanced Warfighting School in Norfolk, VA. Serving as a surface warfare officer in the Navy and subsequently transferring into the Navy Special Warfare community (SEAL), Jamie has served in Europe, the Mediterranean, the Persian Gulf, Iraq, and Afghanistan. Jamie served as the Commander of SEAL Team EIGHT from 2008 to 2010.

Following his military career, Jamie is a Senior Operations Executive providing 20 years experience conducting broad spectrum, complex, special operations in extreme environments to identify and neutralize threats to global security and stability. As a proven problem solver, Jamie is interested in leveraging operational and leadership experience in the private sector.


COMPANY OVERVIEW

Divurgent is not the typical healthcare consulting firm. As a nationally recognized company, we are committed to healthcare evolution and the strategies and processes that make it possible. We help our clients evolve in payment and delivery reform, as well as patient engagement, providing higher quality of care, lower cost of care, and healthier communities.

Focused on the business of hospitals, health systems and affiliated providers, Divurgent believes successful outcomes are derived from powerful partnerships. Recognizing the unique culture that every organization offers, we leverage the depth of our experienced consulting team to create customized solutions that best meet our client’s goals. Utilizing best practices and methodologies, we help improve our client’s operational effectiveness, financial performance, and quality of patient care. For more information about Divurgent, visit us at www.divurgent.com

Redefining Consul�ng. Transforming Healthcare.

REDEFIN ING CONSULTING. TRANSFORMING HEALTHCARE.

Divurgent is committed to healthcare evolution and the strategies and processes that make it possible. We help our clients evolve in payment and delivery reform, as well as patient engagement, providing higher quality of care, lower cost of care, and healthier communities.

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From the Trenches: Leadership Strategies from the US Navy ...€¦ · Divurgent’s Leadership Development Program is based on teaching skills in three core competencies: building